Panel: Scant evidence 'resiliency' programs really work

Feb. 20, 2014 - 03:30PM
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The military has invested millions of dollars in programs to prevent combat-related psychological disorders, but there is little evidence they are effective, an influential scientific panel has concluded.

The Defense Department and military services have dozens of programs aimed at reducing the psychological impact of war and deployments. But many are not “consistently evidence-based or are evaluated infrequently or inadequately,” an Institute of Medicine panel of the National Academies said in a new report, “Preventing Psychological Disorders in Service Members and Their Families, an Assessment of Programs.”

“Some of these programs may be working well, they just haven’t been evaluated well. The Defense Department is devoting scarce resources to a very important problem that all of us would like to see addressed in a manner that maximizes the health of those in the military and their families,” panel chairman and University of Michigan public health professor Kenneth Warner said Thursday.

A Defense Department spokeswoman said DoD is reviewing the IOM report, which it requested to help defense officials “assess program effectiveness” for future planning.

From 2000 to 2011, more than 936,000 troops received diagnoses for a mental health condition, according to the Armed Forces Health Surveillance Center.

To reduce incidents of suicide and possibly ward of psychological problems related to military service, the Army, Navy, Air Force and Marine Corps all have instituted efforts to address combat stress and promote “resilience” by teaching coping skills and positive thinking.

The largest of these is the Army’s Comprehensive Soldier Fitness program, now called Comprehensive Soldier and Family Fitness, or CSF2, a $125 million effort created in 2008 to boost troops’ psychological health.

In an evaluation released in December 2012, the Army said it had scientific proof that the program improves resilience and psychological health and is most effective with 18- to 24-year-olds.

But the IOM panel said the Army’s evidence is based on too small sample size to determine its true effectiveness.

“Like I tell my students, just because something is statistically significant doesn’t mean it’s important,” Warner said. “You want to look at the impact. How many people does it help? Is it worth the money to invest in programs like this?”

On Thursday, an Army spokesman at the Pentagon said the IOM’s interpretation that CSF2 was implemented to prevent post-traumatic stress disorder or depression is flawed.

Lt. Col. Justin Platt said the CSF2 program “is not designed to prevent PTSD or depression but rather to improve the individual and unit’s level of overall fitness in the areas of social, emotional, spiritual, family and physical strength.”

Platt said testimonials show that the program has changed — and saved — lives.

But Roy Eidelson, a psychologist and longtime critic of CSF, said the Army response to the IOM panel’s conclusions is untrue.

“The story is being changed midstream. There is no question if you read the testimony to Congress seeking funding for CSF that this is a program that will prevent PTSD, suicide, depression. Would they have gotten so much money for a program had they not made such outrageous claims?” Eidelson said.

The IOM report makes several recommendations for improving military psychological programs, including boosting strategies that are proven, such as restricting access to personal firearms for those who have suicidal ideations or are involved in domestic violence or restricting the sale of alcohol on base.

The panel also recommended that DoD identify evidence-based strategies designed to prevent domestic abuse and evaluate its programs on violence, substance abuse and other social issues.

Warner said the panel hopes DoD takes its recommendations seriously and added that the department should be lauded for trying to help troops when they were at peak levels of stress.

“In fairness, you have to give lot of credit to DoD for acknowledging these problems, recognizing them and doing something about it. Our issue is how they are going about it,” Warner said.

Eidelson said he hopes the Army implements the IOM panel’s recommendations.

“We so want to effectively address these problems that we are too quick to jump at promising possibilities and too slow to scientifically evaluate them,” Eidelson said. “There’s just no evidence that a universal prevention program works.”